Sexual dating violence victimization and adolescent psychological distress in Rio de Janeiro, Brazil

Background

Studies from high income countries showed physical and psychological dating violence associated with poor mental health (MH) outcomes, including depressive symptoms and suicide attempts. However, sexual dating violence (SDV) has received less attention, especially in low middle-income countries like Brazil. This study investigated the prevalence and the effect of SDV victimization on MH in adolescent students from Rio de Janeiro, Brazil.

Methods

This is a school-based study comprising 550 students enrolled in 13 high schools. Only adolescents reporting at least one romantic relationship in the prior twelve months were eligible. SDV and MH were measured using the Conflict in Adolescent Dating Relationships Inventory (CADRI) and General Health Questionnaire (GHQ-12), respectively. Frequency of SDV was assessed in the aggregate and by specific sociodemographic subgroups. Multivariate logistic models were employed to study the relationship between SDV victimization and MH status. Direct Acyclic Graphs steared the covariates selection process: skin color, maternal education, history of child sexual abuse, and sex.

Results

The prevalence of SDV victimization experienced over the last 12 months was 16.5%. SDV victimization was a significant risk factor for MH problems (OR = 2.04; 95%CI: 1.01 - 4.15).

Conclusions

The high prevalence of SDV among students in the sample was striking. Its relationship with psychological suffering highlights the importance of involving schools and health services in actions aimed at reducing all forms of SDV and at mitigating its consequences. The findings also indicate that mental health professionals should regurlarly investigate SDV victimization among adolescents reporting MH symptoms.

Key messages

Rio de Janeiro schools and health services need to join efforts to develop and implement actions aimed at the prevention of sexual dating violence. Health professionals might investigate if adolescents with psychological distress are also victims of sexual dating violence.

Abusive alcohol consumption among adolescents: a predictive model for maximizing early detection and responses

OBJECTIVE

To present a predictive model of alcohol abuse among adolescents based on prevalence projections in various population subgroups.

STUDY DESIGN

Cross-sectional study.

METHODS

The sample consisted of 785 adolescents enrolled in the second year of high school in Rio de Janeiro, Brazil. Alcohol consumption was assessed using the Alcohol Use Disorder Identification Test. Socio-economic, demographic, family, individuals, and school-related variables were examined as potential predictors. The logit model was used to estimate the prevalence projections. Model fitting was examined in relation to the observed data set, and in a subset, that was generated from 200 subsamples of individuals via a bootstrap process using general fit estimators, discrimination, and calibration measures.

RESULTS

About 25.5% of the adolescents were classified as positive for alcohol abuse. Being male, being 17-19 years old, not living with mothers, presenting symptoms suggestive of binge eating, having used a strategy of weight reduction in the last 3 months, and, especially, being a victim of family violence were important predictors of abusive consumption of alcohol. While the model's prevalence projection in the absence of these features was 8%, it reaches 68% in the presence of all predictors.

CONCLUSIONS

Knowledge of predictive characteristics of alcohol abuse is essential for screening, early detection of positive cases, and establishing interventions to reduce consumption among adolescents.

Gestational weight gain differentials in the presence of intimate partner violence

OBJECTIVE

To assess whether gestational weight gain (GWG) during pregnancy is linked to intimate partner violence (IPV).

METHODS

A total of 394 women being delivered at term at Rio de Janeiro public maternities from March to October 2000 were randomly selected. The Revised Conflict Tactics Scales were used to assess IPV and GWG was expressed through the Net Weight Gain (NWG) indicator. Multiple linear regression was used to control for socioeconomic, demographic, reproductive, and nutritional confounding factors, as well as lifestyle factors such as alcohol, drug, and tobacco consumption.

RESULTS

Even after adjustment, increased physical abuse from male partners was statistically associated with lesser weight gain during pregnancy. Compared with women unexposed to IPV, those with the highest physical abuse score showed deficits of 3245 g and 3959 g, respectively, according to 2 models that did and did not control for lifestyles factors.

CONCLUSION

Physical violence between intimate partners constitutes an independent risk factor for GWG deficit during pregnancy.

Comparison between the abuse assessment screen and the revised conflict tactics scales for measuring physical violence during pregnancy

STUDY OBJECTIVE

Because of the promise of its ability to quickly identify cases of violence against women during pregnancy, the abuse assessment screen (AAS) should be the focus of numerous psychometric evaluations. This paper assesses its measurement accuracy compared with the revised conflict tactics scales (CTS2) used as standard.

DESIGN

Cross sectional study. Besides several ancillary questions, the AAS consists of three anchor questions about violence against pregnant women. These are inclusive, respectively covering lifetime, preceding 12 months, and pregnancy periods. These questions are the main focus of this article. The CTS2 physical aggression scale consists of 12 items divided into minor and severe subscales. A positive event is defined as having at least one positive item in the respective subscale. The 12 item score is also used.

SETTING AND PARTICIPANTS

The instruments were applied to 748 women, 24 to 72 hours after delivery in three major public sector maternity wards of Rio de Janeiro from March to September 2000.

MAIN RESULTS

According to the CTS2, prevalences of minor and severe physical violence perpetrated against a pregnant woman are 18.4% (95% CI 15.7 to 21.4) and 7.6% (95% CI 5.8 to 9.8), respectively. Taking these subscales as standards, sensitivities are 31.9% (95% CI 24.9 to 40.3) and 61.4% (95% CI 47.6 to 74.0), respectively. Specificities are above 97%.

CONCLUSION

These findings are somewhat worrying because the number of victims who are not identified and offered assistance is considerable. On a practical note, it would be sensible not to use the AAS as a stand alone screening tool until more evidence is gathered.

Domestic violence during pregnancy in Rio de Janeiro, Brazil

OBJECTIVES

To estimate the prevalence and risk groups of domestic violence during pregnancy among public health care users in Rio de Janeiro, Brazil. The study focuses on violence perpetrated by both women and partners.

METHOD

526 women giving birth at term in public maternities from March to October 2000 were randomly selected and interviewers used the Revised Conflict Tactics Scales (CTS2).

RESULTS

33.8% [95% confidence interval (CI): 28.8-37.0%] of the respondents reported some form of physical violence and 16.5% (95% CI: 13.3-19.8%) referred to severe forms. A total of 78.3% (95% CI: 74.8-81.8%), 9.9% (95% CI: 7.5-12.7%) and 15.6% (95% CI: 12.6-18.9%) reported psychological aggression, sexual coercion and injuries, respectively. Physical violence mainly occurred among adolescent women with less schooling, who did not work outside the home, with fewer prenatal appointments, and with little social support. Families with more under-five children, alcohol and drug abuse, and low socio-economic status were also involved more frequently.

CONCLUSION

High prevalence rates for various forms of domestic violence in Brazil suggest that the issue should be viewed as a major public health problem.

[Reliability of information on the underlying cause of death from external causes in people under 18 years of age in the Municipality of Duque de Caxias, Rio de Janeiro, Brazil]

This study assesses the quality of official data on mortality due to external causes. It examines the agreement in the underlying cause of death by accidents and violence in children and adolescents under 18 years of age in the Municipality of Duque de Caxias, Rio de Janeiro State. Codings based on death certificates (DC) issued by the Institute of Forensic Medicine - IFM (ICDifm) and those complemented by the Municipal Secretariat of Health - MSH (ICDmsh) are compared to the coding directly obtained from autopsy logs and attached to police reports accessible at the IFM (ICDresearch). Levels of agreement (kappa) between ICDmsh/ICDifm, ICDresearch/ ICDifm, and ICDresearch/ICDmsh were 0.33, 0.26, and 0.81, respectively, in 1995 and 0.26, 0.22, and 0.71 in 1996. When analyzed together, all three sources agreed by 45% and 37.6% in the respective years. ICDresearch and ICDmsh agreed among themselves and disagreed with ICDifm by 46.9% in 1995 and 48.2% in 1996. Results show that the IFM fails to transfer available information to the MSH via DCs. Although a satisfactory updating is subsequently carried out at the MSH, the relevance and legality of this procedure should be called into question and further discussed.

[Minimizing losses and maximizing efficiency in the detection of acute severe malnutrition]

OBJECTIVE

One of the many challenges faced by epidemiologists is to adequately plan and optimize subject selection procedures in terms of effectiveness and efficiency. In the context of a case-control study involving severe acute malnutrition, a two-step subject selection procedure is used. The aim of the article is to establish an appropriate cut-off point for the screening phase and to achieve a common ground for standards, efficiency in detecting severe malnutrition and the two-step procedure.

METHODS

The study includes 154 children under the age of 2 from two different hospitals. To determine the ideal cut-off point of weight-for-age (WFA), the following estimators are of interest: the proportion of false negatives (PFN), false positives (PFP) and the percentage of total gain by time (ptg). Weight-for-height (WFH) (cut-off point at -2 SDs) is used as reference for establishing severe acute malnutrition.

RESULTS

The magnitude of false negatives declines steadily until the 3rd WFA percentile (P3) and reaches zero close to P9. At this point, the PFP is around 0.4. The ptg decreases sharply up to P4, declining smoothly towards P10 thereafter (54.5%).

CONCLUSIONS

The WFA P10 can be recommended for the screening phase. At this cut-off point, there is still efficiency whereas losses of true cases of severe acute malnutrition are minimized.

[Semantic equivalence of the Portuguese version of the Abuse Assessment Screen tool used for the screening of violence against pregnant women]

INTRODUCTION

Research programs and actions regarding family violence have been growing steadily. Therefore, there's a need to develop data collection tools. In Brazil, further problems come up since tools that have been developed elsewhere need to be adapted and translated. This study focuses on the Abuse Assessment Screening (AAS) used to detect violence against pregnant women. The objective is to evaluate the semantic equivalence between the original tool in English and two Portuguese versions, and propose a synthetic version to be used in the field.

METHODS

The evaluation of semantic equivalence was carried out in 4 steps: (1) translation, (2) back translation, (3) formal appreciation of equivalence and (4) a final critical assessment by family violence experts.

RESULTS

Translation, back translation and the steps 3 and 4 assessment are presented for each item of the tool, along with the original in English. The text covers each discussion that led to the final version. Both versions were quite similar in 14 out of 15 items. Nevertheless, the second version showed to be slightly more adequate although for some items the decision was to combine both versions or, in one case, use an item from version 1.

CONCLUSION

The procedure undertaken in this study is discussed in the light of Herdman et al.'s proposal (1998) regarding transcultural equivalence. The study also stresses the importance of using more than one version in the process and the appropriateness of including an additional step about the assessment of the target population's understanding of the tool.

A Bayesian approach to estimate the prevalence of low height-for-age from the prevalence of low weight-for-age

Victora et al. (1998) proposed the use of low weight-for-age prevalence to estimate the prevalence of height-for-age deficit in Brazilian children. This procedure was justified by the need to simplify methods used in the context of community health programs. From the same perspective, the present article broadens this proposal by using a Bayesian approach (based on Markov Chain Monte Carlo (MCMC) methods) to deal with the imprecision resulting from Victora et al.'s model. In order to avoid invalid estimated prevalence values which can occur with the original linear model, truncation or a logit transformation of the prevalences are suggested. The Bayesian approach is illustrated using a community study as an example. Imprecision arising from methodological complexities in the community study design, such as multi-stage sampling and clustering, is easily handled within the Bayesian framework by introducing a hierarchical or multilevel model structure. Since growth deficit was also evaluated in the community study, the article may also serve to validate the procedure proposed by Victora et al.

[Validity of neonatal clinical assessment for estimation of gestational age: comparison of new ++Ballard+ score with date of last menstrual period and ultrasonography]

The objective of this article is to evaluate the accuracy of the New Ballard (NB) score in detecting prematurity. Date of last menstrual period (LMP) and ultrasonography (USG) are used as reference procedures. First, an assessment of inter-observer reliability of the NB score measurements and the USG reports was carried out. Regarding the NB scores, the kappa coefficient and the Intraclass Correlation Coefficient were, respectively, 0.74 (CI 95% 0.49-0.99) and 0.88 (CI 95% 0.78-0.93). For the USG analysis an Intraclass Correlation Coefficient of 0.96 (CI 95% 0.91-0.98) was found. Turning to validity, sensitivity of the NB score was below 0.70 in all but one comparison, irrespective of which procedure was taken as reference. Although specificity was consistently above 0.90, results suggest that the diagnostic ability of the NB score to detect prematurity is far from ideal. The proportion of false negatives may be a warning against its use alone, both in clinical practice and in epidemiological research contexts. Rather, the procedure should be recommended mainly as an accessory diagnostic tool.

[Measurement reliability in a study on family violence and severe acute malnutrition]

INTRODUCTION

This study is nested within a research program related to family violence and severe childhood malnutrition. Its aim is to evaluate the reliability of the data collection process in a case-control study. Four components of the main instrument are addressed: (a) CTS (Conflict Tactics Scales) used to measure violence at the family level; (b) CAGE (Cut-down; Annoyed; Guilty & Eye-opener) questionnaire used to gauge suspicion of drinking problems; NSDUQ (Non-student Drugs Use Questionnaire) used to indicate illicit drug consumption; and (d) height/length measurements.

METHOD

Stability (intra-observer or test-retest reliability) and equivalence (inter-observer reliability) were evaluated for the cited components (a), (b) and (c). Information was replicated among the first 50 subjects selected for the underlying case-control study. The Kappa index (k) was used in the analysis. A pseudo-Bayes adjustment was carried out in order to handle estimation problems. Regarding (d), only equivalence was evaluated (n = 73), using the Intraclass Correlation Coefficient as the estimator.

RESULTS

By and large, all components showed acceptable stability and equivalence. Regarding stability, the estimates of k were around 0.70, 0.78 and 0.85, for CTS, CAGE e NSDUQ, respectively. With respect to equivalence, k was 1.0 for CTS and NSDUQ and 0.75 for CAGE. Equivalence for height/length estimated through the ICC was 0.99. Nevertheless, some deviant situations were detected and are further discussed. The results point to an adequate standardization of observers and reflect the good quality of the data collection procedure concerning the main study, encouraging the research team to press forward with greater assurance.

Paediatric burns and associated risk factors in Rio de Janeiro, Brazil

This is a case-control study conducted at two major public units for paediatric burn injuries in Rio de Janeiro, Brazil. Cases (n = 94) were 0-11-year-old Brazilian children admitted to one of these two burn units. Controls (n = 148) were 0-11-year-old children admitted to the paediatric clinics of the two hospitals where the cases were chosen and from another hospital placed at the same geographic region. Odds ratios (OR) based on logistic regression and 95 percent confidence intervals (95%-CI) were estimated for a number of putative risk factors. The risk of burns was higher for children who lived in crowded households (OR = 2.2; 95%-CI = 1.1-4.7), were not the first-born (OR = 2.5; 95%-CI = 1.2-5.2), had a pregnant mother (OR = 5.0; 95%-CI = 1.2-21.8), had a mother recently dismissed from a job (OR = 7.0; 95%-CI = 1.5-33.9) and had recently moved residence (OR = 4.9; 95%-CI = 1.7-14.3). A history of previous accident had a significant protective effect among males who lived in good environmental conditions (OR = 0.3; 95%-CI = 0.1-0.7), whereas no significant effect was detected in any other strata of gender and living conditions. Proper regulation of design and production of industrial products such as alcohol and domestic stoves, coupled with adequate social support and health education programmes could contribute to lower the incidence of severe burn injuries.

[Prevalence of iron deficiency anemia and risk indicators in children from 12 to 18 months attended at the outpatient clinic of Instituto de Puericultura e Pediatria Martagão Gesteira]

OBJECTIVES

The prevalence of iron deficiency anemia and the associated risk indicators were studied in children from 12 to 18 months at the outpatient unit of IPPMG, in order to evaluate and monitor the service.

METHODS

This is a cross-sectional descriptive study of 288 children seen at the outpatient unit of IPPMG, from January to December 1993. Anemia was diagnosed by dosage of seric hemoglobin. The studied risk indicators were: prenatal care, birth weight, pediatric follow-up, socio-economic aspects, breast-feeding pattern, nutritional status, and iron prescription. Data were computerized and analyzed by EPIINFO and EGRET softwares. Statistical analysis was performed by Pearson chi(2), and breast-feeding pattern was analyzed by the Kaplan-Meier survival curves.

RESULTS

Fifty percent of all children had anemia and 13.2% had severe anemia. Children had an early entry to follow-up at the clinic, and the number of consultations was adequate, according to the recommendations of the Ministry of Health. Only 27% of families had a "per capita" income above one minimum salary, although most had adequate housing and environmental conditions. The median duration of breast-feeding was 7.8 and of exclusive breast-feeding was 3.2 months. No association between anemia and income, early weaning, low-birth weight or undernutrition was found.

CONCLUSION

The prevalence of anemia was extremely high, indicating the need for a specific monitoring system for the occurrence of iron deficiency anemia in this service.

Maternal mental health in a squatter settlement in Rio de Janeiro

The literature on household-based measures of mental health in developing countries is limited. Much emphasis is currently placed on the physical well-being of mothers in relation to child care, yet their mental well-being receives little attention. The present study measures maternal mental health in the largest squatter settlement of Rio de Janeiro, Brazil. The proportion of mothers who were probable cases of mental ill-health was 36%.

[An intra-community profile of nutritional deficiency: a study of children under 5 years of age in a low-income community in Rio de Janeiro (Brazil)]

This study is part of a larger epidemiological study concerned with the health status of children under the age of five carried out in the squatter settlement of Rocinha, and focuses on the nutritional profile of a representative sample of 591 children. According to the weight-for-age criteria (Gomez's classification), 23.9% and 2.0% were, respectively, mildly and moderately malnourished. This finding is in agreement with the assessment using weight-for-height and height-for-age as anthropometric indicators: (a) absence of acute malnutrition (wasting) indicated by a pattern overlapping that of an expected normal population, and (b) growth deficiency (stunting) indicated by 7% and 15% of children exceeding the proportion normally expected to be, respectively, below the -1 and -2 standard deviate limits. So far as growth failure was concerned, the following variables remained associated even when controlling for economic status (indicated by the environmental conditions of the household): low birth weight, number of siblings equal to or above three, male gender, a history of never having breastfed and a family history of previous sibling death. Each variable is discussed separately, as well as the overall nutritional profile and the marked social intra-community stratification related to growth deficit.